Since the pandemic began, Mayo Clinic has seen an influx of patients. But only some of them traveled to Rochester.

“We’re currently touching, caring for more patients on a given day now than they were pre-pandemic when you add in telemedicine activities, plus the patients coming on site for care here,” said Dr. Steve Ommen, a cardiologist and the medical director for experience products for Mayo Clinic's Center for Digital Health.

Video visits skyrocketed more than 5,000% from 278 visits in February 2020 to 16,532 in December at Mayo Clinic-Rochester. Phone telemedicine visits also soared from 169 to 7,590 in the same timeframe, peaking at 24,670 visits in April 2020.

A looming question remains: How will this affect Rochester’s economy when much of the downtown and the largest private-public economic partnership in state history has been built with the presumption that many of Mayo's patients will be visiting the city in person?

The data is too scant to give a definitive answer. But Mayo Clinic experts, along with some preliminary studies from around the country, provide glimpses into how the city may be affected by the increased adoption of telemedicine.

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Who will still travel to Mayo Clinic for medical care?

With Mayo Clinic’s reputation as a provider of specialized treatments, in-person patient care seems rooted in the medical provider's operations. But even as patients prepare to combat rare diseases or undergo complex operations, they may not be traveling to Rochester for the same things they once were.

“There are some things that we can still do remotely, even for patients who do end up having to be on campus for an operation or a specific treatment that might be only available at Mayo,” Ommen said. The services that could be transferred to a telemedicine setting include determining eligibility for a procedure, adjusting dosages for medication or preparing for an operation.

In addition to some aspects of specialized care being conducted remotely, primary care may be transferrable to locations outside the clinic.

Much of Mayo Clinic's patients -- 69% -- are involved in primary or community care, not specialized care. Most of those patients are located in the Midwest, according to Mayo Clinic spokesperson Carol Berteotti.

“We have a larger proportion of that super specialized care, but we also have a very large community care group of patients that we're responsible for who will still be receiving telemedicine that way,” Ommen said.

While it's not clear how the volume of patients in Rochester will change in the coming year, downtown leaders aren't obsessing about how the increased adoption of telemedicine may affect businesses in the area.

Holly Masek, executive director of the Rochester Downtown Alliance, said her team hasn't specifically studied how telehealth use could affect the downtown. The general consensus is that there are enough patients traveling to Rochester for extended stays and more specialized care that businesses will not see a significant decrease in income because of telemedicine use.

"Businesses are focused more on encouraging hybrid workers to make efforts to utilize downtown when they have the option to," Masek wrote in a message.

Fewer Mayo Clinic employees are working downtown than before the pandemic, though telemedicine certainly can't be pinpointed as the sole cause of this shift.

"Approximately 2,900 staff who were previously based in downtown Rochester will now work off campus a majority of the time,” Mayo Clinic spokeswoman Ginger Plumbo said to the Post Bulletin's Jeff Kiger in early July. “This number evolved as Mayo Clinic continued to assess the workforce beyond the initial group of non-clinical administrative staff.”

The number went up from the 1,500 figure Mayo Clinic reported in October 2020.

Destination Medical Center, the largest public-private economic partnership in state history, is built around making Rochester an attractive landing place for Mayo patients and new residents alike. Executive Director Patrick Seeb said telemedicine doesn't negatively affect that goal. In fact, he predicts it will allow more patients to travel here.

"(Telemedicine) really widens the portal of potential patients, families who need to come to Rochester for serious and complicated medical illnesses and treatments," Seeb said. "I really see it as more of an opportunity than a concern, if you will, in terms of the amount of overtime the amount of visitation to chest."

The bottom line for hospitals and patients

While telemedicine may not affect Rochester’s economy, it could affect Mayo’s bottom line.

Preliminary studies from other healthcare institutions across the country provide a picture into how telemedicine use affects revenue. An April 2021 study by the Department of Orthopaedics at the University of Pennsylvania found that the adoption of telemedicine services resulted in just a -.8% hit to the department’s revenue.

“Given that the nation's health systems are operating on thin margins amid rising payment and cost pressures, the findings of our study underscore the need for thoughtful examination to ensure telemedicine is used and supported effectively and sustainably,” read the study.

In terms of the number of employees Mayo needs to support its increased telemedicine patient load, Ommen doesn't expect many more people to join or leave the team. Instead, he said, some of their responsibilities will change.

"It will change some job responsibilities for some employees, it might increase one job category and decrease the potential need for a certain second job category, but I think I don't anticipate a major shift in that," Ommen said.

Some of the economic outlook for the clinic depends on legislation surrounding telemedicine use.

Minnesota has had a telehealth law since 2015, passed after much discourse between patients and providers about cost, fraud and quality.

The location where patients are eligible to receive telehealth services broadened in spring 2020 under emergency power authorization, enabling in-home care, and not solely in-hospital or clinic care. A second change allowed for audio-only care, a shift from previous regulations that restricted telehealth visits to video.

A portrait of Dr. Rodolfo Savica, neurology consultant and professor at Mayo Clinic Medical College, as he would appear during a telehealth visit, on Monday, July 19, 2021. (Traci Westcott / twestcott@postbulletin.com)
A portrait of Dr. Rodolfo Savica, neurology consultant and professor at Mayo Clinic Medical College, as he would appear during a telehealth visit, on Monday, July 19, 2021. (Traci Westcott / twestcott@postbulletin.com)

Legislation passed in June 2021 as part of the Health and Human Services bill made these changes part of law, not just part of the emergency powers declaration.

For Mayo Clinic campuses in Arizona and Florida, the number of patients receiving care via telemedicine may differ. Arizona recently passed similar protections to Minnesota, while Florida rolled back telehealth regulations passed during the pandemic.

Even if Mayo Clinic's bottom line isn't greatly affected by telemedicine use, the patient's pocketbook may be.

A 2014 study found that the average estimated cost of a telehealth visit is $40 to $50 compared to average cost of $136 to $175 for in-person acute care.

Minnesota legislation regulates the cost of telemedicine services to not surpass what the in-person cost would be.

“We've had the law on the books saying' health plans, you must cover telehealth if it's medically appropriate,' and you must pay the same as you would have paid if this service was in person,” said Dave Renner, advocacy director for the Minnesota Medical Association.

The increased flexibility surrounding where appointments can occur also saves patients travel and lodging costs.